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What is premature ovarian insufficiency (POI)?
When menopause comes too early
Part 5 of 5: Perimenopause Awareness Month Series
Premature ovarian insufficiency (POI), also called primary ovarian insufficiency, happens when the ovaries stop working as expected before age 40. You may also hear it called "premature menopause" or "premature ovarian failure", although POI is now the preferred term.
What is the difference between POI and menopause?
POI is not quite the same as menopause. With POI, the ovaries may still release an egg occasionally, and spontaneous pregnancy is still possible, although the chance is low.
POI is also different from diminished ovarian reserve, which means that fewer eggs remain in the ovaries than expected for a person’s age.
What are the symptoms of premature ovarian insufficiency?
People with POI may have irregular or absent periods and symptoms associated with low estrogen, such as hot flashes, night sweats, sleep changes, vaginal dryness, or mood changes. Symptoms can begin in the teenage years, 20s, or 30s. Some people have few or no noticeable symptoms.
What causes POI?
POI can have several causes, including:
Chromosomal or genetic conditions, such as Turner syndrome or Fragile X syndrome
Autoimmune conditions, in which the immune system may affect the ovaries
Medical treatments, including chemotherapy, radiation therapy, or surgery involving the ovaries
POI may also occur alongside other conditions, including autoimmune thyroid disease and type 1 diabetes. In many cases, however, no cause is found.
Recent evidence suggests that POI affects around 3.5% of people under 40 with ovaries, although estimates vary between populations and studies. POI may also be underdiagnosed.
How is premature ovarian insufficiency diagnosed?
Healthcare providers diagnose POI by considering a person’s menstrual history, symptoms, and blood test results. Current international guidance defines POI as irregular or absent periods for at least four months, together with an elevated follicle-stimulating hormone (FSH) level. A low estradiol level can support the diagnosis, but it’s generally not used on its own.
How does POI affect long-term health?
POI can affect more than periods and fertility. Having low estrogen at a younger age is associated with reduced bone density and may affect cardiovascular health. POI can also affect sexual wellbeing, mood, cognitive health, muscle health, and overall quality of life. However, not everyone will experience all these effects, and their impact can vary.
How is premature ovarian insufficiency treated?
Early diagnosis and ongoing care can help protect long-term health. Depending on a person’s needs, care may include hormone therapy, monitoring bone and cardiovascular health, and support for fertility, contraception, sexual wellbeing, and mental health.
Hormone therapy is generally recommended until the usual age of menopause, even when symptoms are mild, unless there is a medical reason not to use it.
Sheree’s story: Diagnosed with POI at 15
Everyone's experience of POI is different. For some people, symptoms begin in their teens, while others don't notice changes until later. Sheree shares what it was like for her to be diagnosed with POI at 15.
My name is Sheree, and I was diagnosed with premature ovarian insufficiency (POI) and infertility when I was 15. I am a UCL Master's graduate and passionate advocate for raising awareness about POI.
My journey to diagnosis was confusing and filled with uncertainty. For years, I dealt with a range of symptoms: frequent headaches, joint pains, forgetfulness, and severe eczema.
I went to the doctor countless times, but each issue was treated separately, and no one thought to look deeper.
It wasn’t until I expressed concern about not starting my period or having any breast development that my doctors finally ran the necessary tests.
I first started showing signs of premature ovarian insufficiency around age 12, but I brushed off the symptoms as just part of puberty. I dealt with cold and hot flashes, skin changes, insomnia, mood swings, and brain fog, assuming it was all part of being a young teen.
It never crossed my mind that these were signs of a health condition, let alone POI. When I finally received my diagnosis, I felt a mix of relief at having answers but also deep sadness and fear about what this meant for my future.
Premature ovarian insufficiency does not just impact your fertility. Like many other female health conditions, it can affect your whole body. Without the right treatment, it can increase your risk of osteoporosis and heart disease and may also be linked to a higher risk of dementia later in life.
However, the biggest impacts for me were the emotional and psychological effects. I felt disconnected from my peers and questioned my own identity as a woman. The physical symptoms were hard, but the hardest part was feeling different and alone.
That feeling of isolation is one of the reasons I created my Instagram and TikTok channels, @lifeofpoi_.
Through these, I aim to normalize conversations around POI and menopause, share my own experiences, and educate others about a condition that is still so often misunderstood or overlooked.
I struggled with feelings of shame and kept my diagnosis to myself, sharing it only with my parents. I didn’t want anyone to see me as abnormal, and like any teenager, I just wanted to fit in.
The best advice I’ve received was to advocate for myself and not be afraid to seek answers, even when doctors dismiss my concerns. For years, I was told things like, "You’re too young to worry about this," or "Just wait, your periods will come," which only delayed my diagnosis. Learning to trust my instincts and push for the care I needed was a game-changer.
If there’s one thing I wish everyone knew before going through menopause, it’s that it’s okay to feel lost, confused, and even angry—it doesn’t make you any less of a person.
There’s no one-size-fits-all experience. It’s important to find the support that works for you, whether that includes hormone therapy, other approaches to managing symptoms, or simply having someone to talk to.
You’re not alone, and you don’t have to navigate POI in silence.
